AILSA CHANG, HOST:
Senate Republicans are nearing a final vote on their tax and spending bill. It's a blockbuster that hits on a number of President Trump's key campaign promises, like making his 2017 tax cuts permanent and approving more money for border security and defense. Trump is demanding that they finish the job, but there is still one big problem, and that is Medicaid. NPR political reporter Elena Moore is on Capitol Hill following all of this and joins us now. Hi, Elena.
ELENA MOORE, BYLINE: Hey, Ailsa.
CHANG: OK, so I saw that voting stretched all through the weekend, which I know senators are always thrilled with...
MOORE: Oh, yeah.
CHANG: ...When that happens. Where do things stand right now?
MOORE: Well, we don't have a final version of the bill yet. Lawmakers are still in the process of voting on amendments, and that's expected to continue into this evening. Democrats have proposed a bunch of changes, but they're getting voted down by Republicans. It's also unclear if any proposed amendments by Republicans will even pass. Senate Majority Leader John Thune can't really afford to lose any more support for the final bill. In a prime - a, you know, a preliminary vote on Saturday, Senator Rand Paul of Kentucky voted no over the deficit, and Thom Tillis of North Carolina voted no over cuts to Medicaid.
CHANG: All right, I want to actually talk about Thom Tillis because I saw that his no vote over the weekend led to his decision not to run for office again, right? What does that tell us about the political stakes for this bill?
MOORE: Yeah, I mean, the stakes are high. Trump has been pressuring senators to make a deal and get this done by July 4. And when lawmakers have pushed back, they've faced consequences. You know, after Tillis voted no on Saturday, Trump vowed to support a primary challenge against him next year. Hours later, Tillis said he wouldn't run. You know, he's been vocal about his opposition to the bill since then. Here's Tillis sending a message directly to Trump on Sunday.
(SOUNDBITE OF ARCHIVED RECORDING)
THOM TILLIS: But I'm telling the president that you have been misinformed. You supporting the Senate mark will hurt people who are eligible and qualified for Medicaid.
CHANG: Ooh-ee (ph). OK, well, let's talk about Medicaid. The program has been a real issue for Republicans throughout this process. What is Tillis flagging here, exactly?
MOORE: Right. And, you know, we're talking about the joint federal and state health care program for low-income, elderly and disabled Americans. That's what Medicaid is. A handful of Republicans, particularly those who represent large rural areas, have been hesitant to support big changes to Medicaid. You know, they say it could seriously hurt, for one, rural hospitals. But at the same time, there's a group of, you know, hard-right fiscal conservatives who still want to see more cuts to the program because they say it'll help the government just offset the costs of this big bill. You know, a senator from Florida, Rick Scott, is introducing an amendment that would reduce how much the federal government contributes to individuals on Medicaid expansion, and that could bring in hundreds of millions in savings.
CHANG: OK - savings, but there is always a trade-off with savings. What would all of those cuts do to insurance coverage, you think?
MOORE: Yeah. Well, Democrats on the Joint Economic Committee say nearly 20 million people could lose health insurance if they pass the bill with Scott's amendment. And even without it, Ailsa, the nonpartisan Congressional Budget Office says almost 12 million people could lose coverage under the current bill. And that could be a real problem for senators Susan Collins of Maine, Lisa Murkowski of Alaska, who have been concerned about Medicaid changes. And remember, I mean, Republicans can only afford to lose three votes. Every vote is critical.
CHANG: That is NPR's Elena Moore. Thank you, Elena.
MOORE: Thanks. Transcript provided by NPR, Copyright NPR.
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